49 Older adults’ experience of transition to the community from the Emergency Department: a qualitative evidence synthesis

Abstract

Abstract Background Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes on discharge. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions, it is important to determine how older adults experience the transition from the ED to the community. This study systematically reviewed and synthesised qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods A systematic literature search of six databases was completed in March 2022 and updated in March 2023. Nine studies were included following full text review representing the experiences of over 490 older adults from five countries. Findings from included studies were synthesised as a meta-ethnography. Results Older adults often reported un-resolved symptoms on discharge (theme 1) which negatively affected transition home and return to daily life. Unresolved symptoms were also a major driver of ED re-attendance shortly after discharge (theme 2). Although older adults wanted a planned discharge home with organised transport (theme 4) however, this was not often achieved. Fragmented care at the point of transition home (theme 3) was a reoccurrence experience for older adults alongside inadequate healthcare provider communication/instructions on ED discharge (theme 5). Conclusion Study findings identified key areas for consideration in service development and intervention development for older adult’s care when transitioning from the ED to the community. ED healthcare providers should consider adapting their communication to meet the needs of older adults. Healthcare providers need to explicitly address expectations about symptom resolution during discharge planning as a collaborative process with older adults. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication from providers and desire to return to daily life.